CONTRACEPTION: 14 COMMON MYTHS – BUSTED

Contraception myths teen couple kissing

How good is your knowledge on contraception? Statistics show that even if contraception awareness is on the rise, there are still a lot of important gaps, and many misconceptions persist.

If you are like most young people, your “education” on birth control comes mainly from your friends, and the internet. And you may have learnt valuable things from them! But there is still a lot of misinformation going around, leading in many cases to misunderstandings and unpleasant surprises…

Following are some of the most common myths, rumours and misperceptions regarding birth control that you should know in order to avoid an unplanned pregnancy.

MYTH # 1: I won’t get pregnant if my partner pulls out before he comes

4eme withdrawal method cartoonThis is one of the most common misconceptions, responsible for many unwanted pregnancies. Also known as the withdrawal method, it has a high rate of contraception failure. This is because some pre-ejaculation fluid (or pre-come) may be released before the man actually ejaculates; this pre-come contains spermatozoids, and it takes only one sperm to get you pregnant! In addition, some men may not have enough self control to withdraw in time…

Keep in mind that pre-ejaculation fluid can also contain sexually transmitted infections, so pulling out will not prevent you from getting an infection.

MYTH # 2: I don’t get pregnant if I have sex during my period

Contraception myths pregnant with periodThe chances of getting pregnant while on your period are low, but it may happen, mainly in women with shorter cycle –i.e., if you get your period every 21-24 days. In such case, your ovulation occurs around the 10th to 12th day after the beginning of your period. Since sperm can live up to 5 days inside your body, if you have sex towards the end of your period, sperm can wait for the egg to be released and you may become pregnant.

But even in women with longer, regular cycles, the ovulation may eventually take place earlier… So remember, you can get pregnant at any time of the month if you have sex without contraception.

MYTH # 3: The morning after pill is dangerous, you can’t take it more than once or twice in your lifetime

Emergency contraception keep-calm-and-take-the-morning-after-pill-7It has been suggested (mostly by internet rumours) that it is dangerous to take the emergency contraception pill more than one or twice in your life. According to the World Health Organisation: “Emergency contraceptive pills are for emergency use only and are not appropriate for regular use as an ongoing contraceptive method because of the higher possibility of failure compared with non-emergency contraceptives. In addition, frequent use of emergency contraception can result in side-effects such as menstrual irregularities, although their repeated use poses no known health risks.” Emergency contraception pills are very safe and do not harm future fertility. Side effects are uncommon and generally mild. Read more about the morning after pill here.

MYTH # 4. I don’t get pregnant if I have sex standing up or if I’m on top

Contraceptive myths teenage couple standing up

Some women believe that having sex in certain positions, such as standing up, sitting down, or if they jump up and down afterwards, they won’t get pregnant as sperm will be forced out of the vagina. In fact, sperm are very strong swimmers! It has been showed that within 5 minutes, sperm are able to reach the tube, where the fertilisation of the egg takes place, and this happens regardless of the position you have sex in.

There’s no such thing as a “safe” position if you’re having sex without a condom or another form of contraception. There are also no “safe” places to have sex, including the bathtub, the shower or the sea.

MYTH # 5. There are only 3 contraceptive options: the condom, the pill and the IUD

Although these three methods are the best-known, there are 15 different methods of contraception (the available options differ in each country). Unfortunately -for women- there are only two choices for men (the male condom and permanent sterilisation). Women have a choice of about 13 methods, including several of long-acting reversible contraception -this means you don’t need to remember to take it or use it every day or every time you have sex.

MYTH # 6. The IUD is not suitable for teenagers and women without children

Contraception myths IUD in teens 1

In the USA, 44% of adolescent girls ages 15 to 19 have had sexual intercourse. Although most of them have used contraception, teenagers frequently use methods with high failure rates -such as withdrawal, or they incorrectly use more reliable methods -such as the pill. In fact, 8 out of every 10 adolescent pregnancies are unintended.

The intrauterine device (IUD), a small device that is inserted into the uterus, has been traditionally reserved to women who have had children. However, new guidelines issued by the American College of Obstetricians and Gynecologists have changed this old perception: the IUD, together with the contraceptive implant, are considered now first-line contraceptive options for sexually active adolescents and young women, as they are the most effective reversible contraceptives for preventing unintended pregnancy, with about 99% effectiveness.

Of course, the IUD and the implant do not protect against sexually transmitted infections, therefore you should also use condoms for that purpose.

MYTH # 7. You can’t get pregnant if it’s the first time you have sex, or if you don’t have an orgasm

Contraception myths sex first timeThese persistent misconceptions are, unfortunately, still responsible for many unplanned pregnancies. If the intercourse takes place during your fertile period, you may become pregnant, whether it’s the first or the hundredth time you’ve had sex, whether you liked it or not.

MYTH # 8. Two condoms are better than one

Contraception myths two condomsCondoms may occasionally break. Many people think that using two condoms (also known as “double bagging”) is safer than using one. Actually, it’s exactly the opposite: using two condoms causes friction between them, increasing the risk of breakage. Thus, two condoms should not be used, neither for pregnancy prevention or for safer sex; this is also true for using a male and a female condom at the same time. When used properly, a male condom  is 98% effective at preventing pregnancy, a female condom is 95% effective.

MYTH # 9. I can use any lubricant together with the condom

Contraception myths personal-lubricant

During intercourse, adding lubricant may ease penetration, so sex is pleasurable and not painful. This is important when, for many reasons (such as stress, medications, taking the pill, etc) the natural wetness of the genital area is reduced.

Lubricants can be made from water, oil, petroleum or silicone; however, when using condoms, water-based lubricants should be used: oil-based products such as petroleum jelly, creams, or baby oil and can damage the latex and make the condom more likely to split, resulting in no contraceptive protection.

Silicone-based lubricants are a newer form of lubrication; they are safe to use with condoms. However, they can be harder to wash off and may cause irritation.

MYTH # 10. If you take the pill for many years, you won’t be able to have children in the future

Contraception myths the pillThis is another very common misconception. After stopping the oral contraceptive pill you may get pregnant immediately, but sometimes it may take two or three cycles for your fertility to fully return, no matter how long you have been using it. Some studies have shown that, within a year after going off the pill, 80% of women trying to get pregnant will get pregnant – exactly like women who were never on the pill.

MYTH #11. You don’t get pregnant if you douche right after sex

Contraception myths vaginal doucheVaginal douching (washing out the vagina) after sex won’t help to prevent a pregnancy. Again, this has to do with spermatozoa being fast swimmers. By the time a woman starts douching, sperm are already well inside the uterine cervix, where no douching solution can reach them.

In fact, you should never douche: douching can lead to many health problems, including problems getting pregnant, vaginal infections and sexually transmitted infections.

MYTH #12. I’m breastfeeding so I can’t get pregnant

Contraception myths breastfeeding

While you’re less fertile when breastfeeding, you may become pregnant; there is no accurate way to predict when fertility returns, even if you breastfeed exclusively. You may not menstruate for several months after giving birth, but at some point you will have your first ovulation -where you can get pregnant- and this will occur two weeks before you get your first period.

Thus, when nursing you should use birth control if you wish to avoid pregnancy.

MYTH # 13. You’re only fertile one day a month

If you have a regular cycle of 28 days, the ovulation usually occurs the 14th day of your cycle. But it’s not only that day that you are fertile. As said before, sperm can live in the cervix for up to 5 days, waiting for the egg to be released. Studies have shown that most pregnancies result from intercourse that takes place during a six-day period ending on the day of ovulation. Once the egg leaves the ovary, in about 24 hours it dies, and the fertile period is over.

However, even in women with a perfectly regular cycle, the hormonal balance involved in the ovulation process can be disrupted by many factors: stress, medications, etc, leading to an earlier or delayed ovulation. Thus, trying to avoid a pregnancy by just having intercourse on the “safe” days can be difficult and may eventually result in an unwanted pregnancy.

MYTH # 14. I don’t need a condom because I’m taking the pill

Contraception myths condomsA survey conducted in France showed that “…one in ten young women ages 15 to 20 is not aware that the pill does not protect against HIV and sexually transmitted infections”. In fact, the only contraceptive method that offers protection against STIs is the condom. Even other barrier methods, such as the diaphragm, do not to keep bacteria out of the vagina, and the pill and IUD offer no STI protection at all.

 

The bottom line:

Don’t be afraid to talk to a doctor about birth control! True, discussing contraception and sexual practices with a healthcare professional may be embarrassing… but it’s better to discuss ways to prevent an unintended pregnancy rather than dealing with one after it happened!

You can do your research before scheduling an appointment -there are many good sites to learn useful information about birth control – but a doctor will help you decide which is the best contraceptive method for you, and how to use it in a proper way.

Knowledge is empowerment! Learn your choices, be aware of the dangers of irresponsible sexual practices, be the advocate for your own sexual health!

 

Find out more about contraception here:

Centers for Disease Control and Prevention, USA. Contraception

National Health System, UK. Your contraception Guide

FPA UK. My contraception tool

 

Photo credits

Intro: evoke.ie; 1: your-life.com; 2: aboutgettingpregnant.com; 3: keepcalm-o-matic.co.uk; 4: pinterest.com; 5: xonecole.com; 6: teenplaybook.org; 7: geekandjock.com; 8: contraception.about.com; 9: hackcrow.com; 10: telegraph.co.uk; 11: aliexpress.com; 12: fidias.net; 13: dailymail.co.uk; 14: blog.path.org; bottom line: contraception-about.com.

THE MORNING AFTER PILL: FACTS AND FICTION

UPDATED JANUARY 2018Morning after pill

“The morning after pill is dangerous”. “You can’t take it more than once or twice in your lifetime”. “If you take it you won’t be able to become pregnant in the future”…

You may have heard all these rumours about the morning after pill and, in case “an accident” happens, you will think twice whether to take it or not… The truth is, the morning after pill has been around for more that 40 years now, but still many misconceptions and controversies persist.

In this article we will try to sort fact from fiction regarding the morning after pill in order to help you make your educated decision…

What is the morning after pill?

Emergency contraception by doctor emergency-contraception_171x200_M9201502The morning after pill, or post-coital pill is a form of emergency contraception that will prevent you from becoming pregnant after an unprotected intercourse, or if a condom breaks during intercourse.

In most countries, there are two types of emergency contraception pills (ECP):

-one containing levonorgestrel (LNG: Norlevo, Levonelle, Plan B, in different countries)

-another containing ulipristal acetate (ella in the USA, EllaOne in Europe).

In many countries such as the UK, France, USA, you may be able to get it (just LNG or both of them) without a prescription.

-When these ECPs are not available, certain ordinary birth control pills can be used as emergency contraception. The regimen is one dose of 4 to 6 pills -depending on the brand- followed by a second dose 12 hours later (the Yuzpe regimen, read more here). If you choose this method, though, it may be a good idea to talk to a health care provider for guidance.

Mifepristone is another highly effective emergency contraception method, available in few countries. However, this medication is also used to induce medical abortion, which may limit its widespread acceptability for use as ECP.

How does it work? Does it cause abortion?

The morning after pill prevents pregnancy by temporarily blocking the egg from being released (that is, inhibits ovulation). In addition, it may stop fertilization. Some people are concerned that the ECP may prevent a fertilised egg from becoming implanted in the uterus, which may be considered as an early abortion. Recent studies have shown that this medication is not effective when ovulation has already occurred, thus it does not seem to prevent implantation. Furthermore, in case an implantation has already occurred before you took it, the morning after pill will not provoke an abortion.

Do I have to take it right away?

Actually “morning after” is a bit of a misnomer: you can take ECP up to five days following unprotected sex. 

Until recently, it was accepted that pills containing LNG (Norlevo, Levonelle, Plan B) should be taken within 72 hours (three days) after the “accident”. However, recent evidence shows that LNG pills continue to be moderately effective if started between 72 and 120 hours; therefore LNG ECP can be taken up to five days after unprotected intercourse.The same is true for EllaOne/ella: it can be safely used up to five days after non-protected sex.

But the sooner you take it, the more effective it is (see below).

Is it effective?

Emergency contraception uhoh_poster_collageNeither type of morning-after pill is 100 per cent effective, but the failure rate is quite low. Like we said, you should take it as soon as possible after unprotected sex, no matter which pill you use. If you take LNG pills within the first 24 hours after sex, they reduce your risk of pregnancy by up to 95%; the efficacy will be reduced the more you delay the ingestion of the pill, roughly to 85% the 2nd day, 60% the third day.

Recent studies have confirmed that EllaOne/ella is more effective than the LNG pill, not only when taken 3-5 days after an unprotected intercourse, but also within the first three days.

Will I get severe side effects?

Emergency contraception pills are very safe: no deaths or serious complications have been ever linked to their use. Moreover, emergency contraception pills do not harm future fertility.

In general, side effects are uncommon and generally mild: the most common are nausea, vomits and menstrual abnormalities (your period may come earlier, later, with more or less blood than usual); more rare side effects are fatigue, breast tenderness, headache and abdominal pain.

There is some controversy as to whether the morning after pill is associated with an increased risk of ectopic pregnancy (a pregnancy outside the uterus, usually inside the fallopian tube). Available evidence suggests that ECP do not increase the chance of ectopic pregnancy; moreover, like all contraceptive methods, they reduce the absolute risk of ectopic pregnancy by preventing pregnancy in general.

Is there any limit to the number of times I can take it?

Emergency contraception womant taking 47929

It has been suggested (mostly by internet rumours) that it could be dangerous to take the ECP more than one or twice in your life. The following is an excerpt from the World Health Organization’s (WHO) site which throws light on this subject:

“There are no restrictions for the medical eligibility of who can use ECPs. Some women, however, use ECPs repeatedly (…) as their main method of contraception. In such situations, further counselling needs to be given on what other and more regular contraceptive options may be more appropriate and more effective. Frequent and repeated ECP use may be harmful for women with conditions classified as medical eligibility criteria (MEC) category 2, 3,or 4 for combined hormonal contraception or Progestin-only contraceptives (POC). Frequent use of emergency contraception can result in increased side-effects, such as menstrual irregularities, although their repeated use poses no known health risks”.

In other words, you shouldn’t take the ECP very often because: 1) you’d rather take the regular contraceptive pills and you will be better protected from unwanted pregnancy; 2) you may get some abnormal periods, BUT IN MOST WOMEN, ECP ARE NOT DANGEROUS! 3) in case you have a severe health problems such as history of stroke, blood clots, certain cancers, etc, then you should avoid frequent and repeat use.

In fact, the Royal College of Obstetricians, says that the LNG pill can be used even more than once in the same cycle. However, it does not recommend taking EllaOne in this way because, being a newer medication, we have not enough evidence for repeated use in the same cycle (although recent evidence indicates that it can be safely used more than once per cycle).

If you find yourself using the morning after pill very often, it might mean that you haven’t yet found a regular method of birth control that works for you. In that case, talk to your doctor about some of your other options.

If ECP fails and I get pregnant, will it affect my unborn baby?

LNG has been used for many years, and evidence shows that there is no increased risk of birth defects or other effects on the baby; new data supports that Ellaone/ella is as safe as LNG and no birth defects have been reported so far.

Can I take ECP if I breastfeed?

You may safely take the LNG pill if you are breastfeeding. Although EllaOne was not recommended during lactation until recently, updated guidelines state that ellaOne is not contraindicated for breastfeeding women, but that breastmilk should not be given to a baby for 24 hours (in the USA guidelines) or one week (in Europe) after a woman has taken the product.

Some final warnings…

  • Emergency contraception keep-calm-and-take-the-morning-after-pill-7The ECP will protect you from an unwanted pregnancy, but it will not provide any protection from sexually transmitted diseases. It is very important that you are aware of safe sexual practices and  incorporate them into your relationships.
  • There is some evidence that the LNG pill might be less effective in women weighting 75kg or more, while the efficacy of EllaOne does not seem to be affected by body weight. Thus, if you are over 75 kg you may prefer to take EllaOne.
  • The efficacy of the ECP will be decreased if you vomit after taking it. If you vomit within 2 hours of taking LNG pill, or 3 hours of taking EllaOne, you will need to take it again.
  • Contraindications: according to the WHO: “There are no medical contraindications to the use of levonorgestrel emergency contraception pills”. Some experts advise against its use in women with severe liver disease.
  • Interaction with other medications: some medications may eventually reduce the effectiveness of the ECP: Saint John’s wort, barbiturates, rifampicin, among others.
  • When to see your doctor: although the ECP may delay your period, contact you doctor if your period doesn’t come some days after the expected time. Likewise, it’s very important that you see your doctor right away if you have irregular bleeding and abdominal pain, to rule out the possibility of an ectopic pregnancy.

The bottom line:

Emergency contraception plan B 1258645.largeThe emergency contraception pill is a safe and effective method of contraception. Most of the rumours you may have heard  about it, are unfounded.

Having said that, it should not be abused.

The (very clever) brand name of the ECP in the USA, Plan B, indicates clearly how this medication should be used: as an option when your plan A (your regular contraception) failed…or wasn’t there.

Related reading:

Contraception: 14 common myths – busted

Fact or myth? Truths, half-truths and misconceptions about the Birth Control Pill

References:

World Health Organization: Emergency Contraception. Fact sheet N°244  June 2017

Trussell J, Raymond E, Cleland K; Emergency Contraception: A Last Chance to Prevent Unintended Pregnancy. November 2017